vitamin-k-semiquinone-radical and Mesenteric-Vascular-Occlusion

In this review, we present some different and special conditions that are generally being treated with anticoagulants such as cerebral vein thrombosis (CVT), mesenteric vein thrombosis (MVT), Budd-Chiari syndrome (BCS), and Pulmonary Hypertension (PH) despite the lack of controlled clinical trials. While either low molecular weight heparins (LMWHs) or unfractioned heparin (UFH) are used in the acute phase of the first three conditions, the potential chronic use of warfarin in PH is controversial. What is not completely known in the management of CVT, MTV, and BCS is whether (a) LMWHs are similar to UFH in terms of efficacy and safety, and (b) a fibrinolytic drug could be employed in the acute phase. The timing at which warfarin should be started, and the duration of its employment are two additional crucial points that deserve to be examined. In the course of PH, the role of warfarin is controversial, but it could be employed after a careful balance of the hemorrhagic and thromboembolic risk. In conclusion, we tried to simplify the approach to this sometimes problematic task considering the available literature with the aim of providing some practical skills to be used by physicians in their daily clinical practice. Since it is improbable that in the future controlled clinical trials will be designed to find the optimal anti-thrombotic management of these conditions, we believe that a physician should be aware of the lack of solid data in the field but at the same time should always exert clinical judgment when considering an aggressive anticoagulant approach. The duration of oral anticoagulant treatment is left to the clinical judgment of the balance between the hemorrhagic and thrombotic risks in any single patient.

Topics: Anticoagulants; Chronic Disease; Decision Making; Female; Follow-Up Studies; Humans; Hypertension, Pulmonary; Intracranial Thrombosis; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Patient Selection; Risk Assessment; Treatment Outcome; Vitamin K

Eighteen patients with an acute thrombosis of the splanchnic veins were reviewed. Most of apparently idiopathic cases of splanchnic vein thrombosis are related to an increased coagulation related to a congenital or acquired defect of haemostasis. The aim of this study was to assess the effects of a new and effective treatment. Nine male and 9 female patients (range of age: 19 to 81 years) experienced a mesenteric venous thrombosis. There were 14 mesenteric vein thromboses with infarction, two transient mesenteric venous ischaemias without bowel infarction and two acute thromboses of the splanchnic veins without bowel ischaemia. A coagulopathy was detected in seven patients: oral contraception, protein C (PC) or antithrombin III (AT III) congenital deficiencies, acquired deficiency of AT III, PC and protein S (PS), polycythaemia in the post-partum period and primary myeloproliferative disorder. No coagulopathy was associated with thrombosis in eight cases: mesenteric haematoma, splenomegaly, cirrhosis, appendicectomy, cholescytectomy, chronic heart failure, treatment with beta-adrenergic receptor antagonist and digitalis, stenosis of the portal anastomosis after liver transplantation. Twelve patients required surgery: eight intestinal bowel resections with immediate anastomosis, four resections without immediate anastomosis. Only one patient underwent a second look for a repeat bowel resection. No death occurred in the early postoperative period and 17 out of 18 patients were alive after 12 years. An oral anticoagulant therapy was undertaken from two months to seven years. However, three patients suffered a recurrent thrombosis. Two of them required a long-term anticoagulation. Six patients experienced a portal hypertension and oral anticoagulants were discontinued in three of them because of bleeding oesophageal varices. Six patients were treated only by unfractionated heparin (UFH) or low molecular weight heparin (LMWH) followed by oral anticoagulants. After laparotomy, two were only treated with UFH without any bowel resection, as mesenteric venous ischaemia was too extensive. These observations suggest that the choice between an appropriate medical or surgical treatment is important and must be discussed. Since 1989, the therapeutic choice has been modified by ultrasonography and contrast enhanced computed tomographic scan which confirms diagnosis, allows to follow up and check the effects of anticoagulation and to choose the time for surgery. When the

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Antithrombin III; Blood Coagulation Disorders; Female; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Protein C Deficiency; Protein S Deficiency; Risk Factors; Thrombosis; Vitamin K

The antiphospholipid syndrome had been rarely reported as a cause of mesenteric venous thrombosis.. We report two exceptional cases of primary antiphospholipid syndrome associated with mesenteric venous thrombosis in 51 years old man and 27 years old women.. Identifying the underlying process is very important to try to propose a specific treatment.

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Female; Fibrinolytic Agents; Follow-Up Studies; Heparin, Low-Molecular-Weight; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Time Factors; Treatment Outcome; Venous Thrombosis; Vitamin K

Topics: Anticoagulants; Celiac Disease; Diagnosis, Differential; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Thromboplastin; Thrombosis; Vitamin K

Topics: Aged; Electrocardiography; Hemoperitoneum; Humans; Intestinal Obstruction; Male; Mesenteric Vascular Occlusion; Middle Aged; Myocardial Infarction; Vitamin K; Warfarin